There’s a good post under the “Economix” column on the NY Times site discussing why health care costs so much in the USA. A Princeton economist named Uwe Reinhardt writes that the USA spends about 40 percent more per capita for health care than what other developed nations spend, as adjusted for GDP per capita. Some of that cost involves our greater use of specialists and tests due to “defensive medicine” practices (i.e. doctors having to cover their butts in fear of lawsuits). Some of it is just the “brotherhood” of doctors making enough work to keep everyone in business; studies have found that in cities where there are a lot of specialists, the average use of specialists per patient goes up. Unfortunately, this does not result in better health. Some of it might be that we invent the latest and most expensive machines, drugs and procedures, and are the first to use them. But a study by the McKinsey Global Institute found that about 21 percent of the excess spending is due to administration and insurance overhead costs.
In other words, our crazy system, with its health care corporations, insurance companies and government agencies shooting paperwork back and forth, requires a lot of people cross-checking each other, making sure that their organization isn’t left “holding the bag” for unexpected costs of patient care and treatments. Some of the administration cost also goes for insurers designing and marketing “gold-plated policies” to rich people who can afford truly humane and decent health coverage.
I’ve said before that capitalism and health care don’t mix. I’m all in favor of free international markets for computers and refrigerators and long-distance phone calls and socks and sealing wax; if you get a computer that doesn’t work right or some sealing wax that doesn’t seal, you can get past that and move on. But when you make a mistake about buying health care, it can be fatal. And when you depend on your employer to buy health care for you, then you’re letting someone else play with your life.
We accept a certain degree of socialism here in America. We allow state control and coordination of certain critical things that don’t get done properly under free markets. Those include schooling, police and fire protection, garbage collection, etc. We want to make sure that these things, which are essential to everyone, are fully accessible to everyone, not just to the rich. Unfortunately, health care is now less and less available to the poor and even the middle class. It’s time to bring health care into the crypto-socialism fold. There may still be a role for private enterprise in providing services, but only in the context of a government guaranteeing a reasonable level of care for everyone. I honestly hope that’s where President Obama and all his friends in Congress will soon take us. The American health care system is sick, and is making Americans sicker than they need be.
Jim,
I can’t say what I think about the health care system at this point–because I do not have any coherent thoughts on exactly how the health care system should be changed.
I do know that it has changed massively over the years and, even more importantly, that there is an extremely large group of people “out there” who simply have no health insurance whatsoever.
As to this second group of people: I personally know of one individual who has no health care at all. He and others who care about him simply hope that he does not become ill with some serious problem that requires major “doctoring.” And I think of all the people who work on that principle–simply hoping that they do not require EVER any major doctor-care. What a terrible indictment of this country.
As to doctors: I am old enough to remember when doctors actually came to one’s house to visit a sick person. I remember our family doctor visiting me at home when I was very ill with some respiratory infection that had gotten out of hand. And sure, then they did not even have penicillin; medical care was primitive then by the standards of today.
However, there is a strange paradox about medical care today. I’ve personally been told on an occasion or two that “you shouldn’t be driving”–meaning I was so ill I should not have driven to the medical care center by myself. All I could do was answer: “Would you have come to my house to treat me since there was no one available who could bring me here?” That question stumped the doctor. A strange lack of understanding on the part of the medical personnel–specifically, the doctor.
I’ve also noticed (or does it just happen to be the doctors I see) a strange kind of collusion between the doctor and medical companies. At times the doctors I’ve seen lately seem to have hundreds of thousands of dollars of medical equipment “on loan” somehow. Either the medical equipment eventually becomes a stable of the doc’s practice or it suddenly disappears, never to be seen again. No forthcoming explanation seems to be the case. I have a theory about that situation….
As to employers buying health care for individuals, let me be specific: My sister has had some harrowing experiences. She at one time (I don’t know if she still has the same policy or health care insurance company) had Cigna. Routinely(!), all submissions of ANY health care claims were denied–no matter how emergent the situation happened to be, no matter what the situation. My sister happens to know her way around the health care provider system and so spent long hours appealing and requesting reconsiderations of denials–only eventually and with reluctance on the part of Cigna to have her claims paid. This eventual payment tells one that the claim should have been paid in the first place. All this type of handling of health care claims does is make the situation worse for the person who requires serious medical care. If my sister had not known her way around the health care system, she’d have been on the hook for the claims she filed. And I think of all the thousands (millions?) of health care claims that were denied; the individuals involved may have been too ill or too uninformed about the labyrinthine bureaucracy involved in filing denied claims, etc. And how terrible to take such advantage of people in distress.
Oddly enough, some time after Cigna had received some massively unfavorable publicity for their practice of routinely denying claims, no matter how valid, I received a call from a “research institute.” For some odd reason I consented to answer their “15 minute” questionnaire over the phone. At first the questions started out very generally. But it soon became apparent that the real purpose of the questionnaire was to find out exactly how badly the unfavorable publicity had affected the public image of Cigna. I have to say that I may have played into their hand by roundly castigating Cigna in my answers. Yet, I must say that the questions were couched in su
Comment by MCS — November 29, 2008 @ 11:02 am
Jim,
I can’t say what I think about the health care system at this point–because I do not have any coherent thoughts on exactly how the health care system should be changed.
I do know that it has changed massively over the years and, even more importantly, that there is an extremely large group of people “out there” who simply have no health insurance whatsoever.
As to this second group of people: I personally know of one individual who has no health care at all. He and others who care about him simply hope that he does not become ill with some serious problem that requires major “doctoring.” And I think of all the people who work on that principle–simply hoping that they do not require EVER any major doctor-care. What a terrible indictment of this country.
As to doctors: I am old enough to remember when doctors actually came to one’s house to visit a sick person. I remember our family doctor visiting me at home when I was very ill with some respiratory infection that had gotten out of hand. And sure, then they did not even have penicillin; medical care was primitive then by the standards of today.
However, there is a strange paradox about medical care today. I’ve personally been told on an occasion or two that “you shouldn’t be driving”–meaning I was so ill I should not have driven to the medical care center by myself. All I could do was answer: “Would you have come to my house to treat me since there was no one available who could bring me here?” That question stumped the doctor. A strange lack of understanding on the part of the medical personnel–specifically, the doctor.
I’ve also noticed (or does it just happen to be the doctors I see) a strange kind of collusion between the doctor and medical companies. At times the doctors I’ve seen lately seem to have hundreds of thousands of dollars of medical equipment “on loan” somehow. Either the medical equipment eventually becomes a stable of the doc’s practice or it suddenly disappears, never to be seen again. No forthcoming explanation seems to be the case. I have a theory about that situation….
As to employers buying health care for individuals, let me be specific: My sister has had some harrowing experiences. She at one time (I don’t know if she still has the same policy or health care insurance company) had Cigna. Routinely(!), all submissions of ANY health care claims were denied–no matter how emergent the situation happened to be, no matter what the situation. My sister happens to know her way around the health care provider system and so spent long hours appealing and requesting reconsiderations of denials–only eventually and with reluctance on the part of Cigna to have her claims paid. This eventual payment tells one that the claim should have been paid in the first place. All this type of handling of health care claims does is make the situation worse for the person who requires serious medical care. If my sister had not known her way around the health care system, she’d have been on the hook for the claims she filed. And I think of all the thousands (millions?) of health care claims that were denied; the individuals involved may have been too ill or too uninformed about the labyrinthine bureaucracy involved in filing denied claims, etc. And how terrible to take such advantage of people in distress.
Oddly enough, some time after Cigna had received some massively unfavorable publicity for their practice of routinely denying claims, no matter how valid, I received a call from a “research institute.” For some odd reason I consented to answer their “15 minute” questionnaire over the phone. At first the questions started out very generally. But it soon became apparent that the real purpose of the questionnaire was to find out exactly how badly the unfavorable publicity had affected the public image of Cigna. I have to say that I may have played into their hand by roundly castigating Cigna in my answers. Yet, I must say that the questions were couched in such a way as to make it seem to someone not acquainted with Cigna and their practices that the questionnaire was “neutral” and dealth with a survey of all health care systems. I have yet to see any action taken by Cigna (in the form of advertising, for instance) as to what a great company they are and what terrific services they have to offer. So perhaps Cigna did not suffer that much from the bad publicity they received and continue their practices.
Then there is Hillary Clinton and whatever role she may play in the Obama administration and/or the promise made by Obama himself about health care and the American public. Even if she becomes the Secretary of State, I would hope that she can influence the incoming administration or that the Obama administration itself does something seriously effective in providing a health care system to all those who have no health care at all and whose only “health care” is to hope against hope they do not become ill in any way that requires any serious medical care.
MCS
Comment by MCS — November 29, 2008 @ 11:02 am
Jim,
I can’t say what I think about the health care system at this point–because I do not have any coherent thoughts on exactly how the health care system should be changed.
I do know that it has changed massively over the years and, even more importantly, that there is an extremely large group of people “out there” who simply have no health insurance whatsoever.
As to this second group of people: I personally know of one individual who has no health care at all. He and others who care about him simply hope that he does not become ill with some serious problem that requires major “doctoring.” And I think of all the people who work on that principle–simply hoping that they do not require EVER any major doctor-care. What a terrible indictment of this country.
As to doctors: I am old enough to remember when doctors actually came to one’s house to visit a sick person. I remember our family doctor visiting me at home when I was very ill with some respiratory infection that had gotten out of hand. And sure, then they did not even have penicillin; medical care was primitive then by the standards of today.
However, there is a strange paradox about medical care today. I’ve personally been told on an occasion or two that “you shouldn’t be driving”–meaning I was so ill I should not have driven to the medical care center by myself. All I could do was answer: “Would you have come to my house to treat me since there was no one available who could bring me here?” That question stumped the doctor. A strange lack of understanding on the part of the medical personnel–specifically, the doctor.
I’ve also noticed (or does it just happen to be the doctors I see) a strange kind of collusion between the doctor and medical companies. At times the doctors I’ve seen lately seem to have hundreds of thousands of dollars of medical equipment “on loan” somehow. Either the medical equipment eventually becomes a stable of the doc’s practice or it suddenly disappears, never to be seen again. No forthcoming explanation seems to be the case. I have a theory about that situation….
As to employers buying health care for individuals, let me be specific: My sister has had some harrowing experiences. She at one time (I don’t know if she still has the same policy or health care insurance company) had Cigna. Routinely(!), all submissions of ANY health care claims were denied–no matter how emergent the situation happened to be, no matter what the situation. My sister happens to know her way around the health care provider system and so spent long hours appealing and requesting reconsiderations of denials–only eventually and with reluctance on the part of Cigna to have her claims paid. This eventual payment tells one that the claim should have been paid in the first place. All this type of handling of health care claims does is make the situation worse for the person who requires serious medical care. If my sister had not known her way around the health care system, she’d have been on the hook for the claims she filed. And I think of all the thousands (millions?) of health care claims that were denied; the individuals involved may have been too ill or too uninformed about the labyrinthine bureaucracy involved in filing denied claims, etc. And how terrible to take such advantage of people in distress.
Oddly enough, some time after Cigna had received some massively unfavorable publicity for their practice of routinely denying claims, no matter how valid, I received a call from a “research institute.” For some odd reason I consented to answer their “15 minute” questionnaire over the phone. At first the questions started out very generally. But it soon became apparent that the real purpose of the questionnaire was to find out exactly how badly the unfavorable publicity had affected the public image of Cigna. I have to say that I may have played into their hand by roundly castigating Cigna in my answers. Yet, I must say that the questions were couched in su
Comment by MCS — November 29, 2008 @ 11:02 am